| NPI | 1669830311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL APRN11014078) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 660745) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 660745) | |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2023-12-12 |